| NPI | 1962282178 |
|---|---|
| Doing Business As | COASTAL PHARMACY PROVIDENCE |
| Entity Type | Organization |
| Authorized Contact | LAUREN PETTIS Executive Director 251-625-6896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-10-04 |